EXACT WITH GAP
& CO-PAY COVER
Cover for specific procedures that your
medical scheme excludes, with
additional gap and co-payment cover.
Monthly premiums
Why choose Exact with Gap and CoPay?
The Exact with Gap and Co-Pay option provides cover for specific procedures that your medical scheme excludes, with additional Gap and Co-payment cover for the events that are covered by the medical scheme. The Exact Cover option provides access to a defined list of stated procedures when your Medical scheme option excludes those specific procedures over and above their standard exclusions. Sirago will negotiate with all service providers on your behalf and pay the claim directly, up to the stated amounts as listed below. The cost of the hospital and all service providers are included in the cover limit.” TO: “Sirago will negotiate with all service providers on your behalf and pay the claim directly, up to the stated amounts as listed under the Exact benefit cover. The cost of the hospital and all service providers are included in the cover limit.
Key benefits
OAL per beneficiary per annum: R223 000 (from 1 April 2026)
In-hospital Benefits
Gap Cover
Co-payments
The excesses imposed by your medical scheme payable to a maximum rand limit for specified procedures or tests. Cover for co-payments imposed by medical schemes for hospital admissions, scans and surgical procedures. Co-payment benefits are subject to OAL per policy per annum, limited to R15 000 per claim, including co-payments charged as a percentage.
Value-added Benefits
Casualty Benefit
Sub-limit of R10 00 for Accident/Trauma and Child Casualty Illness; costs related to the illness benefit for children 12 years and younger; stated benefit, R2 000 per claim.
Procedures we cover
Arthroscopic Surgery | R100 000 |
Back and neck surgery and treatment | R100 000 |
Bunion surgery | R100 000 |
Cochlear implant, auditory brain implant and internal nerve stimulator surgery including the device and processor | R100 000 |
Dental procedures for reconstructive plastic surgery due to an accident | R100 000 |
Dental procedures for impacted wisdom teeth for children under 18 year old | R15 000 |
Functional nasal surgery | R100 000 |
Joint replacement surgery | R100 000 |
Oesophageal reflux and hiatus hernia surgery | R100 000 |
Varicose vein surgery | R100 000 |
MRI and CT scans due to an accident | R10 000 |
Skin disorders including benign growth and lymphomas | R100 000 |
Non-cancerous breast conditions | R100 000 |
Tonsillectomy, grommets, and adenoidectomy | R12 000 pp, R20 000 combined procedure |
Explore our gap products
Ultimate Gap Cover
Our most comprehensive option with an extensive range of benefits.
From
R645
per month
Exact Gap Cover
Get cover for specific procedures excluded by your medical scheme.
